Flagship report urges investment in a continuum of care for mothers and newborns

Mariama Coulibaly, 16, sits on a bed in the maternity ward at Vélingara Health Centre in the town of Vélingara, in Senegal’s southern Kolda Region.

By Elizabeth Kiem

NEW YORK, USA, 15 January 2009 – UNICEF’s flagship publication, ‘The State of the World’s Children 2009’ – launched today in South Africa – addresses maternal mortality, one of the most intractable problems for development work.

Having a child remains one of the biggest health risks for women worldwide. Fifteen hundred women die every day while giving birth. That’s a half a million mothers every year.

“It’s really an unconscionable number of deaths. It’s a human tragedy on a massive scale,” says UNICEF Chief of Health Dr. Peter Salama.

Greatest health divideIn the past decade, concerted interventions have shown an impact in the survival of young children – but this progress has not translated to mothers.

The difference in pregnancy risk between women in developing countries and their peers in the industrialized world is often termed the greatest health divide in the world.

A woman in Niger, for example, has a one in seven chance of dying during the course of her lifetime from complications during pregnancy or delivery. That’s in stark contrast to the risk for mothers in the United States, where it’s 1 in 4,800, or in Ireland, where it’s just 1 in 48,000.

Empowering womenHigh maternal mortality rates are found disproportionately in African and Asian countries, particularly in post-conflict conditions. There is also a close correlation between maternal deaths and societies with high fertility rates.

In the very countries where women are expected to have many children, they face disproportionate risks during pregnancy, according to UNICEF Gender Specialist Noreen Khan.

“I’m shocked sometimes. I cannot see why there is such a contradiction,” she says. “You place so much importance to my being a mother and at the same time you are not attaching importance to my health in terms of allocating resources, or even attention.”

Essential interventionsAddressing that gender disconnect is a multidisciplinary challenge requiring an emphasis on education, human resources, community involvement and social equality.

'The State of the World's Children 2009' says women must be guaranteed, at a minimum, antenatal care, skilled birth attendants, emergency obstetrics, adequate nutrition and postpartum care.

These essential interventions will only be guaranteed within the context of improved gender equality and the abolition of discrimination. Providing more educational opportunity for girls will also empower them to make healthier reproductive choices and better understand the risks of pregnancy.

Newborns benefit from maternal careAnd providing better maternity and obstetric care for mothers has a direct impact on the survival of newborns. Almost 40 per cent of all deaths under the age of five occur in the first 28 days of life.

Women stand outside Malalai Hospital in Afghanistan, a country with one of the highest maternal mortality rates in the world.

“Maternal health is inextricably linked to newborn health,” says Dr. Salama. “Pregnancies that end in pre-term labour … result in a much higher risk of [newborn] death.”

Dr. Salama notes that progress has been made in eliminating newborn tetanus and malaria by either vaccinating or otherwise protecting the mother during pregnancy. In addition, babies benefit from the attention of medical providers in communities where postpartum care is regular.

Awareness and educationThe timing and causes of maternal and newborn deaths are well-known, and so are many of the ways to prevent them.

Prenatal health problems and obstetric complications can be reduced by increased training and human resources, for example. And cultural traditions impeding women from delivering with assistance can be confronted with more awareness and, of course, education.

UNICEF’s new report advocates a ‘continuum of care’ to empower young women and improve their chances of having a healthy pregnancy and a healthy infant.